Individual provider Active NPI

Glyn E Marsh, MD

  • Otolaryngology Physician
  • Walla Walla, WA
National Provider Identifier
1336163005
Registry record updated Apr 19, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Otolaryngology PhysicianTaxonomy code 207Y00000X
License
MD00022960 Issued in WA
Practice address
301 W Poplar St
Suite 210
Walla Walla, WA 99362
Phone
(509) 522-5825
Fax
(509) 529-3512
NPI assigned
Jul 27, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 19, 2012

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Otolaryngology Physician 207Y00000X MD00022960 WA Primary

Addresses

Primary practice location

301 W Poplar St
Suite 210
Walla Walla, WA 99362

Mailing address

PO Box 34439
Seattle, WA 98124-1439

Other identifiers 2

IdentifierTypeStateIssuer
1336163005MedicaidWA
127886MedicaidOR

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1153958400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1334793600000",
    "number": "1336163005",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 34439",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981241439"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "301 W POPLAR ST",
            "address_2": "SUITE 210",
            "city": "WALLA WALLA",
            "state": "WA",
            "postal_code": "99362",
            "telephone_number": "509-522-5825",
            "fax_number": "509-529-3512"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARSH",
        "first_name": "GLYN",
        "middle_name": "E",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-27",
        "last_updated": "2012-04-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "WA",
            "license": "MD00022960",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1336163005",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "127886",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Walla Walla, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 19, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.